Insurance Companies Sometimes Reluctant to Pay for Open Wound Treatments

By Deborah Hirsch
TMCnet Contributor

Wouldn’t you think an insurance company would want to help patients heal open wounds? After all, these wounds can lead to severe pain, infection, gangrene, amputation and sometimes even death.

But many of the companies who have invested millions to develop products to heal open wounds – a $1.8 billion market – have not been able to get their treatments to the public or stay afloat, “because insurance companies often refuse to pay for their products,” according to a story by Wendy Lee at the Minneapolis StarTribune.

Chronic wounds can range from bedsores to surgical incisions that don't heal, according to the story. There are many reasons why wounds may not heal, including poor blood flow to the affected area, autoimmune diseases and cancer. Sometimes the elderly take longer to heal because skin becomes harder to heal as we age and if they are undernourished, that can also lead to the inability of the skin to repair itself, according to informedhealthonline.org.

And why insurance companies won’t pay for products to heal open wounds continues to puzzle patients and doctors as the market is only expected to growwith the aging of the populationand the number of people with Type 2 Diabetes soars, Lee writes.

"When new technologies come out that are beneficial, the process is so darned slow," Gary Goetzke, an insurance reimbursement consultant, told Lee. "It's really hard to get Medicare and others to recognize good technologies and pay for it."

Still, some Minnesota medical device start-ups like Bloomington-based Advanced Healing Institute and Wound Care Technologies in Chanhassen tell Lee “they've developed treatments that work better than traditional wound therapy like skin grafts.” These companies have also found ways to get their treatments covered, she writes.

The Advanced Healing Institute has succeeded because it partnered with Fairview Health Services, which is funded through the Minnesota Senior Health Options program, and administered by the Minnesota Department of Human Services and nine HMOs, according to Lee. 

Lee reports that the institute says its relationship with Fairview “helps it to clear the reimbursement hurdle,” while the hospital additionally benefits “because it avoids the long-term costs of treating the wound, along with related infections.”

Unhealed open wounds are a serious health problem. "We understand these types of patients are at risk. Therefore, if we pay for wound care earlier rather than later, we actually avoid costs downstream," Dr. David Moen, president of Fairview Physician Associates, told Lee.

Deborah DiSesa Hirsch is an award-winning health and technology writer who has worked for newspapers, magazines and IBM (News - Alert) in her 20-year career. To read more of her articles, please visit her columnist page.